Correction to: Search of anti-allodynic compounds from Plantaginis Semen,a crude drug ingredient of Kampo formula “Goshajinkigan”

Journal of Natural Medicines - The article Search of anti-allodynic compounds from Plantaginis Semen, a crude drug ingredient of Kampo formula “Goshajinkigan”.     

Variation in patient position and impact on carbon-ion scanning beam distribution during prostate treatment

Objective:

We assessed the impact of changes in patient position on carbon-ion scanning beam distribution during treatment for prostate cancer.

Methods:

68 patients were selected. Carbon-ion scanning dose was calculated. Two different planning target volumes (PTVs) were defined: PTV1 was the clinical target volume plus a set-up margin for the anterior/lateral sides and posterior side, while PTV2 was the same as PTV1 minus the posterior side. Total prescribed doses of 34.4 Gy [relative biological effectiveness (RBE)] and 17.2 Gy (RBE) were given to PTV1 and PTV2, respectively. To estimate the influence of geometric variations on dose distribution, the dose was recalculated on the rigidly shifted single planning CT based on two dimensional–three dimensional rigid registration of the orthogonal radiographs before and after treatment for the fraction of maximum positional changes.

Results:

Intrafractional patient positional change values averaged over all patients throughout the treatment course were less than the target registration error = 2.00 mm and angular error = 1.27°. However, these maximum positional errors did not occur in all 12 treatment fractions. Even though large positional changes occurred during irradiation in all treatment fractions, lowest dose encompassing 95% of the target (D₉₅)-PTV1 was >98% of the prescribed dose.

Conclusion:

Intrafractional patient positional changes occurred during treatment beam irradiation and degraded carbon-ion beam dose distribution. Our evaluation did not consider non-rigid deformations, however, dose distribution was still within clinically acceptable levels.

Advances in knowledge:

Inter- and intrafractional changes did not affect carbon-ion beam prostate treatment accuracy.The depth dose distribution for a charged particle beam exhibits a Bragg peak at the end of range, which is particularly sensitive to variation in tissue density along its path length. For this reason, changes in patient position perturb charged particle beams more strongly than photon beams.¹ Of the two major treatment uncertainties, intrafractional motion and interfractional changes, treatment accuracy for the prostate appears more strongly affected by interfractional changes.^2–7 Clinical protocols now incorporate several approaches to overcoming these uncertainties, including acquisition of radiographs or cone beam CT images.However, despite these technical solutions to intra- and interfractional changes and improvements in patient positional accuracy during the patient set-up procedure, treatment accuracy may also be affected by positional changes during treatment. Most treatment centres do not check patient positional accuracy after treatment beam irradiation, because approaches to adjusting distribution in the next fraction to compensate for under-/overdosage in the preceding have not been developed and because patient position is assumed not to change during treatment. Our hospital has been providing carbon-ion scanning beam treatment since 2011.⁸ The average time from complete patient set-up to complete beam irradiation was 2.6 min. Although this is relatively short, we have no quantitative data on the effect of patient positional change on carbon-ion scanning dose distribution.In this study, we evaluated patient positional change during treatment and its impact on carbon-ion scanning dose distribution in treatment of the prostate.     

Membrane voltage-dependent activation mechanism of the bacterial flagellar protein export apparatus

The proton motive force (PMF) consists of the electric potential difference (Δψ), which is measured as membrane voltage, and the proton concentration difference (ΔpH) across the cytoplasmic membrane. The flagellar protein export machinery is composed of a PMF-driven transmembrane export gate complex and a cytoplasmic ATPase ring complex consisting of FliH, FliI, and FliJ. ATP hydrolysis by the FliI ATPase activates the export gate complex to become an active protein transporter utilizing Δψ to drive proton-coupled protein export. An interaction between FliJ and a transmembrane ion channel protein, FlhA, is a critical step for Δψ-driven protein export. To clarify how Δψ is utilized for flagellar protein export, we analyzed the export properties of the export gate complex in the absence of FliH and FliI. The protein transport activity of the export gate complex was very low at external pH 7.0 but increased significantly with an increase in Δψ by an upward shift of external pH from 7.0 to 8.5. This observation suggests that the export gate complex is equipped with a voltage-gated mechanism. An increase in the cytoplasmic level of FliJ and a gain-of-function mutation in FlhA significantly reduced the Δψ dependency of flagellar protein export by the export gate complex. However, deletion of FliJ decreased Δψ-dependent protein export significantly. We propose that Δψ is required for efficient interaction between FliJ and FlhA to open the FlhA ion channel to conduct protons to drive flagellar protein export in a Δψ-dependent manner.

The ion motive force (IMF) across the cell membrane is one of the most important sources of biological energy in any cell. The IMF is utilized for many essential biological activities, such as ATP synthesis, solute transport, nutrient uptake, protein secretion, flagella-driven motility, and so on (1). The IMF is the sum of the electrical (Δψ) and chemical (ΔpI) potential differences of ions such as protons (H⁺) (the proton motive force [PMF]) and sodium ions (Na⁺) (the sodium motive force [SMF]) across the membrane and is defined by Eq. 1:IMF=Vm+kBTq ln[ion]in[ion]ex,[1]where V_m is Δψ; [ion]_in and [ion]_ex are the internal and external ion concentrations, respectively; k_B is Boltzmann’s constant; T is the absolute temperature (in kelvins); and q is the charge of the ion. The Δψ corresponds to the membrane voltage (2).The flagellum of the enteric bacterium Salmonella enterica serovar Typhimurium (hereafter referred to as Salmonella) is a supramolecular motility machine consisting of the basal body, which acts as a bidirectional rotary motor; the hook, which functions as a universal joint; and the filament, which works as a helical propeller. The Salmonella flagellar motor is powered by a PMF across the cytoplasmic membrane. The motor consists of a rotor and multiple stator units, each of which acts as a transmembrane proton channel complex. The stator unit converts the proton influx through the channel into the force for high-speed rotation of the long helical filament (3, 4).For construction of the hook and filament structures at the cell exterior, a specialized protein transporter utilizes the PMF to transport flagellar building blocks to the distal end of the growing flagellar structure. The flagellar protein transporter consists of a PMF-driven export gate complex made of five transmembrane proteins, FlhA, FlhB, FliP, FliQ, and FliR, and an ATPase ring complex consisting of three cytoplasmic proteins, FliH, FliI, and FliJ (SI Appendix, Fig. S1) (5, 6). These proteins are evolutionarily related to those of the virulence-associated type III secretion systems of pathogenic bacteria, which inject effector proteins into eukaryotic host cells for invasion (7). Furthermore, the entire structure of the ATPase ring complex is structurally similar to the cytoplasmic F₁ part of F_OF₁-ATP synthase, which utilizes the PMF for ATP synthesis (8–10).FliI forms a homo-hexamer that hydrolyzes ATP at an interface between neighboring FliI subunits (10–12). FliJ binds to the central pore of the FliI ring (9). ATP hydrolysis by the FliI ATPase not only activates the transmembrane export gate complex through an interaction between FliJ and the C-terminal cytoplasmic domain of FlhA (FlhA_C) (13, 14) but also opens the entrance gate of the polypeptide channel through an interaction between FliI and the C-terminal cytoplasmic domain of FlhB (FlhB_C) (15). As a result, the export gate complex becomes an active proton/protein antiporter that couples an inward-directed H⁺ flow with an outward-directed protein export (SI Appendix, Fig. S1) (16). When the cytoplasmic ATPase complex becomes nonfunctional, the FlgN chaperone activates the Na⁺-driven export engine of the export gate complex over a wide range of external pH, allowing the export gate complex to drive Na⁺-coupled protein export (17, 18). The transmembrane domain of FlhA (FlhA_TM) acts as a transmembrane ion channel for the transit of both H⁺ and Na⁺ across the cytoplasmic membrane (17).A chemical potential gradient of either H⁺ (ΔpH) or Na⁺ (ΔpNa) is required for efficient inward-directed translocation of H⁺ or Na⁺ when FliH and FliI are absent (13, 17). Although the Δψ component is critical for flagellar protein export by the wild-type export gate complex (19), it remains unknown when and how Δψ is used for the flagellar protein export process. To clarify this question, we used the Salmonella MMHI0117 [ΔfliH-fliI flhB(P28T)] strain (hereafter referred to as ΔHI B*; Table 1) (20), in which the export gate complex uses both Δψ and ΔpNa at different steps of the flagellar protein export process (13, 17). We show that an increase in Δψ generated by an upward shift of the external pH from 7.0 to 8.5 activates flagellar protein export by this mutant even in the absence of ΔpNa, suggesting the presence of a Δψ-dependent activation mechanism for proton-coupled protein secretion by the export gate complex. We also show that an increased Δψ facilitates efficient docking of FliJ to FlhA_C.Table 1.Summary for flagellar protein export properties of Salmonella strains used in this study

Effects of oral befunolol on heart rate and systolic blood pressure during submaximal exercise in man

For the purpose of determining exercise intensity required for evaluating the effect of beta-blocking agents, the multi-stage treadmill exercise was carried out up to intensity of 85% of maximal oxygen intake (VO2max) after administration of beta-blocking agents in 7 healthy men. To obtain a stable dose response in the inhibitory effect of beta-blocking agents on heart rate (HR) and systolic blood pressure (S-BP), the exercise intensity more than 65% of VO2max (75% of maximal heart rate) was needed. In order to evaluate the effect of befunolol (BFE), a submaximal treadmill exercise of 75% of the age adjusted predicted maximal heart rate was loaded in 6 healthy men at 1.5, 4, and 8 hours following a single oral administration of 10 mg, 20 mg or 40 mg of BFE and 20 mg or 40 mg of propranolol. Simultaneously, the plasma concentration of BFE was determined 1.5, 4, 6 and 8 hours after the administration of BFE at each dose. In human serum, BFE was detected together with its metabolite, revealing a significant correlation between BFE and metabolite (r = 0.94, p < 0.001). Almost a certain rate of metabolite (4--5 times) was detected against BFE. As for the biological half life, it was 1.79 +/- 0.13 hours with BFE and 3.67 +/- 1.33 hours with metabolite. The inhibitory effect of BFE on HR and S-BP during exercise exhibited a dose response with the oral dose and its plasma concentration, and was almost twice as much as that of propranolol at the same dose. Accordingly, the myocardial oxygen consumption which may be represented as rate pressure product was inhibited twice as much as propranolol. BFE is characteristic of its more rapid elimination of its effect compared to the other beta-blocking agents. The decrease in the inhibitory effect of BFE or HR during exercise was about 1.8 times quicker than that of propranolol.